This SBIR project is designed to enable the migration of very effective real-time gait biofeedback technology into rehabilitation clinics, hospitals, and other organizations working with impairments or injury. Real-time gait biofeedback has long been used successfully for rehabilitation of injury, for correcting gait patterns associated with impairment, and perhaps more importantly, for correcting gait patterns associated with the risk of impairments such as osteoarthritis. The potential of such systems is virtually limitless because they are non- invasive and can be based on a vast array of objective measurements and performance indices. The usage of such systems in everyday clinical practice is currently limited, however, in part by costs in excess of $100K for a 3D motion capture system with dedicated laboratory space managed by a highly trained operator, and the lack of standardized training/retraining protocols. We propose overcoming these barriers by producing a low cost, straightforward to operate real-time biofeedback gait retraining system that can be modified to work with multiple clinical protocols. The product will be a commercial system for gait (walking and running) retraining, consisting of a treadmill, streaming 3D Motion Capture and biomechanical analyses, and a video feedback display for less than $15K, and anticipated advances in technology (such as hybrid systems using low-cost accelerometers) may even reduce this cost. The key is in leveraging a new generation of low cost 3D motion capture equipment with an established set of protocols and a new software system that C-Motion can develop based on our high end Visual3D biomechanics research tools. Visual feedback (real-time graphs, gauges, and other displays) will be generated from custom software leveraging C-Motion's Visual3D libraries by creating a new product called Feedback3D. Feedback3D will initially be integrated with a low-cost optically based 3D Motion Capture system using NaturalPoint Optitrack Flex:V100R2 cameras, ADtech's AMASS calibration and 3D reconstruction software. The real need for such a system has been validated through surveys and interviews with clinicians in the real world, customer requests for such a product, combined with the experience and observations of researchers, clinicians, and existing motion capture users. In Phase I we will develop a prototype version of Feedback3D that will lay the groundwork for a Phase II project by demonstrating that a less expensive biofeedback system yields similar effectiveness to high end laboratory systems. More importantly, in collaboration with the Bader Consortium (see letter of support) we will address the other barriers listed above by establishing a process for the creation and documentation of standardized protocols that will make this a practical clinical tool. PUBLIC HEALTH RELEVANCE: Gait Retaining via real-time motion capture feedback has been used successfully for many decades to modify gait patterns that have been associated with injuries or orthopedic issues related to walking and running gait. By addressing underlying mechanical problems early in the rehabilitation process it improves outcomes, helps reduce the recurrence of injury, as well as the long term consequences of the abnormal mechanics, such as osteoarthritis, and can reduce or even eliminate pain. The problem to resolve is that systems to provide this type of retraining are extremely expensive, complicated, they require large facilities and highly trained operators, and provide results in a scientific manner that is difficut for a busy clinician to interpret. This SBIR project (Phase 1 and 2) is designed to overcome these current barriers to practical real-time biofeedback systems by producing a low cost, straightforward to operate real-time biofeedback gait retraining system. The system is modular and can be adapted quickly to multiple clinical protocols and thus target a wide range of patient populations. Since reimbursement for gait retraining already is covered under existing CPT codes, a low cost biofeedback retraining system should be financially self-sufficient and will ultimately allow the proposed system to have tremendous broad impact by bringing standardized, objective, and research-based biofeedback training to the everyday clinical setting. Phase 1 is designed to validate the effectiveness of low-cost systems and their ability to capture meaningful data in a quick and useful manner. It also will result in a prototype real-time biofeedback software package that can evolve into a commercial application. The Phase 2 project will be to leverage the prototype tools to define the processes, standards, and initial clinical protocols, with feedback displays and the biomechanical parameters necessary to address correcting gait patterns associated with impairments or injuries.